Rühmann Oliver, Schmolke Stephan, Bohnsack Michael, Flamme Christian, Wirth Carl Joachim
Orthopaedic Department, Hannover Medical School, Hannover, Germany.
J Shoulder Elbow Surg. 2005 Jan-Feb;14(1):38-50. doi: 10.1016/j.jse.2004.05.008.
Complications after shoulder arthrodesis are frequent. Through results and comparisons with the literature, the presented article analyzes the correlation of complications with the specific operative techniques, indications, and postoperative treatment. Between 1964 and 2001, a total of 43 cases of shoulder arthrodesis (13 screw and 30 plate arthrodeses) were performed and then analyzed after a mean of 6.7 years (range, 0.5-36 years). Surgery was carried out on 10 female patients (23%) and 33 male patients (77%) with a mean age of 35 years (range, 11-82 years). These patients had the following indications: paralysis (32 [74%]), osteoarthritis or humeral head necrosis (15 [35%]), infection (7 [16%]), and persistent shoulder instability (6 [14%]). The extent of active movement after arthrodesis was 56 degrees abduction (range, 20 degrees - 90 degrees) and 60 degrees forward flexion (range, 20 degrees - 105 degrees), with an increase in the Constant score in all cases, from a mean of 27 points preoperatively to 57 points postoperatively (difference, 30 points). The patients rated the outcome of surgery as excellent, good, or satisfactory in 91% of cases. Complications after shoulder arthrodesis were noted in 12 of 43 patients (28%). The most frequent complications after screw/plate arthrodesis included pseudarthrosis, 2 (15%)/3 (10%); infection, 1 (8%)/4 (13%); and fracture of the humerus, 0/4 (13%). No specific judgment can be attributed to the different osteosynthesis techniques used in shoulder arthrodesis, either in the cases presented at our clinic or in the literature. Pseudarthrosis appeared to be less frequent in cases of plate arthrodesis compared with screw arthrodesis. However, the application of plates resulted more often in infection, postoperative fractures of the humerus, and the necessity for removal of material. Particularly in patients with paralysis, a shoulder arthrodesis resulted in an improvement in postoperative active function and presented a suitable operative option.
肩关节融合术后并发症很常见。通过研究结果并与文献进行比较，本文分析了并发症与特定手术技术、适应症及术后治疗之间的相关性。1964年至2001年间，共进行了43例肩关节融合术（13例采用螺钉固定，30例采用钢板固定），平均随访6.7年（范围0.5 - 36年）后进行分析。手术对象为10例女性患者（23%）和33例男性患者（77%），平均年龄35岁（范围11 - 82岁）。这些患者的适应症如下：瘫痪（32例[74%]）、骨关节炎或肱骨头坏死（15例[35%]）、感染（7例[16%]）以及持续性肩关节不稳定（6例[14%]）。融合术后主动活动范围为外展56度（范围20度 - 90度）和前屈60度（范围20度 - 105度），所有病例的Constant评分均有所提高，从术前平均27分提高到术后57分（差值30分）。91%的患者对手术结果评价为优秀、良好或满意。43例患者中有12例（28%）出现肩关节融合术后并发症。螺钉/钢板融合术后最常见的并发症包括假关节形成，螺钉固定组2例（15%）/钢板固定组3例（10%）；感染，螺钉固定组1例（8%）/钢板固定组4例（13%）；肱骨骨折，螺钉固定组0例/钢板固定组4例（13%）。无论是在我们诊所的病例中还是在文献中，都无法对肩关节融合术中使用的不同骨固定技术做出具体评判。与螺钉融合术相比，钢板融合术假关节形成似乎较少见。然而，使用钢板更常导致感染、术后肱骨骨折以及需要取出内固定材料。特别是对于瘫痪患者，肩关节融合术可改善术后主动功能，是一种合适的手术选择。
